Clover Health Launches New Portal Availity® Essentials™ to Empower Providers and Improve the Patient Experience
WILMINGTON, Del., Sept. 16, 2025 (GLOBE NEWSWIRE) -- Clover Health Investments, Corp. (NASDAQ:CLOV) ("Clover," "Clover Health" or the "Company"), a physician enablement company dedicated to bringing access to great healthcare to everyone on Medicare, is leveraging Availity, the nation's largest real-time health information network, for a multi-phase initiative designed to increase operational efficiency across administrative functions for providers while improving patient access to timely, quality care.
Across the healthcare system, providers face significant challenges managing prior authorizations, eligibility checks, and claims. These processes can take the focus away from patient care and create unnecessary administrative burden that can delay treatment and impact patient outcomes. As part of Clover's strategic commitment to operational excellence, the Company is investing in solutions that directly address these challenges while ensuring providers know their voices are heard and valued in shaping these improvements.
Key Enhancements
- Centralized Access: A single, highly secure interface that allows providers to manage core administrative tasks across multiple health plans. This streamlined access means providers can spend more time with patients and less time navigating multiple systems.
- Streamlined Prior Authorizations: Faster, more efficient approval workflows designed to reduce delays in patient care.
- Real-Time Transparency: Tools for instant eligibility verification and advanced claims tracking, giving providers the information they need when they need it.
"Providers have been clear - they need less red tape and more support in focusing on patients," said Jamie Reynoso, CEO of Medicare Advantage at Clover Health. "This new portal is one of several steps we're taking to ease administrative burden, accelerate decision-making, and deliver on our commitment to a more efficient provider experience, empowering them to focus on what they do best: delivering high quality care to their patients, faster."
This collaboration is enabled by Availity's position as the nation's largest dual-sided network in healthcare, including 3.4 million providers, thousands of health IT vendors, and direct connectivity to more than 95 percent of health plans.
The new portal will be implemented in phases to ensure optimal performance and provider experience while minimizing any disruption to patient care. Clover is currently partnering with pilot providers to refine the system before expanding access across its full provider network.
"Clover Health's rollout of our Availity Essentials demonstrates how health plans and providers can work together through Availity's dual-sided network to reduce friction and deliver measurable value," said Russ Thomas, CEO of Availity. "This collaboration reflects our vision for empowering stakeholders to make better decisions, experiences, interoperability, and scale in service of improving patient outcomes."
This rollout builds on Clover Health's ongoing strategic initiatives to make working with the Company more efficient and less complex while improving the member experience, including:
- Reducing the number of procedure codes requiring authorization, focusing only on areas with the highest potential for fraud, waste, or abuse.
- Expanding electronic submissions underpinned by clinician reviews, with a majority of prior authorizations now processed digitally and more approved instantly. This enables providers to receive immediate feedback and proceed with patient care without delays, reducing administrative overhead.
Looking ahead, Clover is committed to working with providers and CMS to further accelerate prior authorization electronic submission adoption through standardized data and submission elements (using FHIR® APIs), expand real-time coverage determinations, and enhance determination transparency. This past month, Clover Health signed on as a CMS-Aligned Network early adopter, pledging to work collaboratively to enable the CMS Interoperability Framework goals and confirming Clover's belief in a future where seamless care coordination and data-sharing for the patients' needs are the norm, not the exception.
About Clover Health:
Clover Health (NASDAQ:CLOV) is a physician enablement technology company committed to bringing access to great healthcare to everyone on Medicare. This includes a focus on seniors who have historically lacked access to affordable, high-quality healthcare. Our strategy is powered by our software platform, Clover Assistant, which is designed to aggregate patient data from across the healthcare ecosystem to support clinical decision-making and improve health outcomes through the early identification and management of chronic disease. For our members, we provide PPO and HMO Medicare Advantage plans in several states, with a differentiated focus on our flagship wide-network, high-choice PPO plans. For healthcare providers outside Clover Health's Medicare Advantage plan, we extend the benefits of our data-driven technology platform to a wider audience via our subsidiary, Counterpart Health, and aim to enable enhanced patient outcomes and reduced healthcare costs on a nationwide scale. Clover Health has published data demonstrating the technology's impact on Medication Adherence, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease as well as the earlier identification and management of Diabetes and Chronic Kidney Disease.
Visit: www.cloverhealth.com
Investor Relations:
Ryan Schmidt
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About Availity
Availity empowers payers and providers to deliver transformative patient experiences by enabling the seamless exchange of clinical, administrative, and financial information. As the nation's largest real-time health information network, Availity develops intelligent, automated, and interoperable solutions that foster collaboration and shared value across the healthcare ecosystem. With connections to over 95% of payers, more than 3 million providers, and over 2,000 trading partners, Availity provides mission-critical connectivity to drive the future of healthcare innovation. For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn.
Media Contact:
Matt Schlossberg
Director of Public Relations, Availity
630-935-9136
[email protected]
